Prior childbirth experience and attitude towards subsequent vaginal birth after one caesarean delivery in Lagos, Nigeria: a cross-sectional study.

BACKGROUND: Prior caesarean delivery (CD) impacts CD rates in many parts of the world. In low and middle-income countries, few women attempt a trial of labour after caesarean delivery (TOLAC) due to inadequate resources for safe vaginal birth after caesarean delivery (VBAC). The CD rates continue to rise as more women undergo repeat CD. In Nigeria, VBAC rate is low and the contribution of women's prior childbirth experiences and delivery wishes to this situation deserves further investigation. This study examined the parturient factor in the low VBAC rate to recommend strategies for change. OBJECTIVE: To describe prior caesarean-related childbirth experiences and attitudes towards subsequent vaginal birth in pregnant women with one previous CD. METHOD: This cross-sectional study of antenatal clinic attendees in a tertiary hospital employed the convenience sampling method to recruit 216 consenting women with one previous CD. Structured questionnaires were used to collect information on participants' prior caesarean-related birth experiences, attitudes to vaginal birth in the index pregnancy, future delivery intentions and eventual delivery route. Univariate and bivariate analyses compared delivery wishes based on CD type. SPSS version 22.0 was used for data analysis. RESULTS: The modal maternal and gestational age groups were 30-39 years (68.1%) and 29-34 weeks (49.1%) respectively; majorities (60.6%) were secundigravida; 61.6% experienced labour before their CDs while 76.9% had emergency CDs. Complications were documented in 1.4% and 11.1% of mothers and babies respectively. Ninety percent reported a satisfactory overall childbirth experience. A majority (83.3%) preferred TOLAC in the index pregnancy because they desired natural childbirth while 16.7% wanted a repeat CD due to the fear of fetal-maternal complications. The previous CD type and desire for more babies were significantly associated with respondents' preferred mode of delivery (p = 0.001 and 0.023 respectively). Women with previous emergency CD were more likely to prefer vaginal delivery. CONCLUSIONS: Antenatal women prefer TOLAC in subsequent pregnancies despite prior satisfactory caesarean-related birth experiences. Adoption of TOLAC in appropriately selected cases will impact women's psyche positively and reduce CD rate.

Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria.

BACKGROUND: Caesarean delivery carries a risk of major intra-operative blood loss and its performance is often delayed by non-availability of blood and blood products. Unnecessary cross-matching and reservation of blood lead to apparent scarcity in centres with limited supply. This study set out to identify the risk factors for blood transfusion in women who underwent caesarean delivery at a tertiary obstetric unit with a view to ensuring efficient blood utilization. METHODS: A prospective cohort analysis of 906 women who had caesarean deliveries at the Lagos State University Teaching Hospital, Nigeria between January and December, 2011. A comparison was made between 188 women who underwent blood transfusion and 718 who did not. Data were obtained on a daily basis by investigators from patients, clinical notes and referral letters using structured pre-tested data collecting form. Socio-demographic characteristics; antenatal, perioperative and intraoperative details; blood loss; transfusion; and puerperal observations were recorded. EPI-Info statistical software version 3.5.3 was used for multivariable analysis to determine independent risk factors for blood transfusion. RESULTS: Of the 2134 deliveries during the study period, 906 (42.5%) had caesarean deliveries and of which 188 (20.8%) were transfused. The modal unit of blood transfused was 3 pints (41.3%). The most common indication for caesarean section was cephalo-pelvic disproportion (25.7%).The independent risk factors for blood transfusion at caesarean section were second stage Caesarean Section (aOR = 76.14, 95% CI = 1.25-4622.06, p = 0.04), placenta previa (aOR = 32.57, 95% CI = 2.22-476.26, p = 0.01), placental abruption (aOR = 25.35, 95% CI = 3.06-211.02, p < 0.001), pre-operative anaemia (aOR = 12.15, 95% = CI 4.02-36.71, p < 0.001), prolonged operation time (aOR = 10.72 95% CI = 1.37-36.02, p < 0.001), co-morbidities like previous uterine scar (aOR = 7.02, 95% CI = 1.37-36.02, p = 0.02) and hypertensive disorders in pregnancy (aOR = 5.19, 95% CI = 1.84-14.68, p < 0.001). Obesity reduced the risk for blood transfusion (aOR = 0.24, 95% CI = 0.09-0.61, p = 0.0024). CONCLUSION: The overall risk of blood transfusion in cesarean delivery is high. Paturients with the second stage Caesarean section, placenta previa, abruptio placentae and preoperative maternal anaemia have an increased risk of blood transfusion. Hence, adequate peri-operative preparations for blood transfusion are essential in these situations. Optimizing maternal hemoglobin concentration during antenatal period may reduce the incidence of caesarean-associated blood transfusion.

Sexual assault in Lagos, Nigeria: a five year retrospective review.

BACKGROUND: Cases of sexual assault are increasingly reported. However, Nigerian researchers have not given adequate attention to this subject despite its attendant social, physical and psychological consequences.This study assessed survivors' characteristics, circumstances of assault and treatment offered with a view to reducing the incidence as well as improving evaluation and management. METHODS: A retrospective review of survivors' case records at Lagos State University Teaching Hospital, Ikeja, between January 2008 and December 2012. Data was analysed using the Epi-info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta U S A. RESULTS: Of the 39,770 new gynaecological cases during this period, 304 were alleged sexual assault giving an incidence of 0.76% among hospital gynaecological consultations. Only 287 case notes had sufficient information for statistical analysis. Of these, 83.6% were below 19 years, 73.1% knew their assailants (majority were neighbours), most assaults (54.6%) occurred in the neighbours' homes and over 60% of victims presented after 24 hours of assault. Although 77.3% were assaulted at daytime, teenagers were likely to be raped during the day and non-teenagers at night (P < 0.001). Threat and physical violence were mostly used to overcome victims. Seventy three point six percent had Human Immunodeficiency Virus (HIV) screening with one positive at onset. Post Exposure Prophylaxis for HIV was given in 29.4% of those eligible and emergency contraception in 22.4% of post-menarcheal victims (n = 125). There were neither referrals for psychotherapy nor forensic specimen collected. No record of post-assault conception or HIV infection was found during follow-up. CONCLUSIONS: Adolescents remain the most vulnerable requiring life skills training for protection. Survivors delay in presenting for care. Therefore, public enlightenment on the benefits of early interventions and comprehensive care of survivors with the use of standardized protocols are recommended.